The Global Fund’s New Funding Model (NFM) has passed its pilot phase. The upcoming GFATM Board Meeting (November 7/8 in Geneva) will tie up some of the loose ends. Full roll-out of the NFM is envisaged for 2014. This is great news. But: Geneva, we have a problem!

New Allocation Criteria a Bitter Pill for Many

One of the most fundamental shifts in the NFM is the newly developed allocation criteria for countries and diseases. In a nutshell, the NFM tries to correct a perceived distortion in the way the Fund’s resources have historically been distributed. At the core is a calculation of epidemiological data such as HIV, TB or malaria disease burden, coupled with a measure of a country’s “ability to pay”. The latter is an assumption based on the respective country’s income ranking according to World Bank Criteria. This model might work well to increase funds for the poorest countries with the highest disease burden in Africa and elsewhere. However, some perceive the Global Fund’s use of national income and disease burden as the only two main allocation criteria  a ‘blunt tool’ that cannot truly indicate where the greatest needs really are.

The trouble starts if you happen to be born in Russia or many others so called middle- or high-income countries in the region referred to as Eastern Europe and Central Asia (EECA)[1]. The region has a high burden of Multi Drug Resistant Tuberculosis and is the only place globally where HIV continues to rise. Many EECA countries face quite concentrated epidemics. In essence this means that, e.g. HIV or TB does not affect so much the general population – yet – but is spreading primarily in what is referred to as Most at Risk Populations (MARPS).

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